Objective To investigate the causes and clinical characteristics of spontaneous convexal subarachnoid hemorrhage (cSAH) complicated with acute ischemic stroke (AIS). Methods Clinical data of 160 cases of cSAH patients hospitalized in our department from January 2012 to January 2020 were collected and retrospectively analyzed. Patients were divided into cSAH group and cSAH combined with AIS group according to whether patients were complicated with AIS. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison according to different data types. Results Among the 160 cSAH patients, 23 cases were combined with AIS. Comparison of clinical data between the 2 groups showed that the patients combined with AIS had significantly higher male ratio, older age, and greater ratios of hypertension, diabetes, hyperlipidemia, chronic cerebral infarction and smoking than the cSAH patients (P<0.05). What′s more, limb weakness and numbness and middle cerebral artery stenosis were more common in the cSAH combined with AIS group than the cSAH group (P<0.05). Conclusion For the elderly cSAH patients with cerebrovascular disease risk factors, especially those with intracranial large vessel stenosis, great attention should be paid to the symptoms and signs of focal nervous system involvement, and the focus should be on improving the head MRI and cerebrovascular examination to determine whether AIS is complicated, so as to avoid missed diagnosis and misdiagnosis.